Natural History of Histologically-proven Alcohol Related Liver Disease: A systematic review

Parker, Richard; Aithal, Guruprasad P; Becker, Ulrik; Gleeson, Dermot; Masson, Steven; Wyatt, Judith I; Rowe, Ian A

Abstract

Background:
Studies into the natural history of alcohol related liver disease (ArLD) to date have lacked long-term follow-up, large numbers of participants, or both. We performed a systematic review to summarise studies that describe the natural history of histologically-proven ARLD.
Methods:
PubMed and Medline were searched for relevant studies according to prespecified criteria. Data were extracted to describe the prevalence of ArLD, histological progression of disease and mortality. Single proportion meta-analysis was used to combine
data from studies regarding rates of progression or mortality.
Results:
Thirty-seven studies were included, reporting data from 7,528 participants. Amongst cohorts of hazardous drinkers, on average 15% had normal histological appearances, 27% had hepatic steatosis, 24% had steatohepatitis and 26% had cirrhosis. Annualised progression of pre-cirrhotic disease to cirrhosis were 1% (0-8%) in patients with
normal histology, 3% (2-4%) in hepatic steatosis, 10% (6-17%) in steatohepatitis and 8% (3-19%) in fibrosis. Annualised mortality was 6% (4-7%) in patients with steatosis and 8% (5-13%) in cirrhosis. In patients with steatohepatitis on biopsy a marked difference was seen
between inpatient cohorts (annual mortality 15%, 8-26%) and mixed cohorts of inpatients and outpatients (annual mortality 5%, 2-10%). Only in steatosis did non-liver related mortality exceed liver-specific causes of mortality (5% per year vs. 1% per year).
Conclusions:
These data confirm the observation that alcohol related hepatic steatohepatitis requiring admission to hospital is the most dangerous sub-type of ArLD. Alcohol-related steatosis is not a benign condition as it is associated with significant risk of
mortality. There were insufficient data to reliably describe the effect of drinking behaviour on progression of disease or on mortality, or to describe outcomes beyond crude mortality rates, highlighting the need for high-quality natural history studies.

Citation

Parker, R., Aithal, G. P., Becker, U., Gleeson, D., Masson, S., Wyatt, J. I., & Rowe, I. A. (2019). Natural History of Histologically-proven Alcohol Related Liver Disease: A systematic review. Journal of Hepatology, 71(3), 586-593. https://doi.org/10.1016/j.jhep.2019.05.020

• Journal Article Type: Article
• Acceptance Date: May 22, 2019
• Online Publication Date: Jun 5, 2019
• Publication Date: 2019-09
• Deposit Date: Jun 12, 2019
• Publicly Available Date: Jun 6, 2020
• Journal: Journal of Hepatology
• Print ISSN: 0168-8278
• Electronic ISSN: 1600-0641
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 71
• Issue: 3
• Pages: 586-593
• DOI: https://doi.org/10.1016/j.jhep.2019.05.020
• Keywords: Alcoholic liver diseases, Natural history, Review, systematic, Meta-analysis
• Public URL: https://nottingham-repository.worktribe.com/output/2180160
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S016882781930306X
• Additional Information: This article is maintained by: Elsevier; Article Title: Natural history of histologically proven alcohol-related liver disease: A systematic review; Journal Title: Journal of Hepatology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jhep.2019.05.020; Content Type: article; Copyright: © 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
• Contract Date: Jun 12, 2019